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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 4  |  Page : 263-267

Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey


Department of Physiotherapy, MGM College of Physiotherapy, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India

Date of Submission29-May-2018
Date of Acceptance20-Sep-2019
Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. Jyoti Abhay Parle
MGM College of Physiotherapy, Sector 18, Kamothe, Navi Mumbai - 410 209, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_49_18

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  Abstract 


BACKGROUND: Currently, the Government of India is providing comprehensive integrated health care to the rural people under the umbrella of National Rural Health Mission. A village level community health worker “Accredited Social Health Activist (ASHA)” acts as an interface between the community and the public health system. A time-to-time assessment of the knowledge of ASHAs is essential as the success of government's health programs in rural areas depends on them, and hence, this research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare.
SETTINGS AND DESIGN: A cross-sectional study was done at Panvel Taluka in Raigad District of Maharashtra. The study participants were Trained ASHA workers.
MATERIALS AND METHODS: A cross-sectional study was conducted in rural field practice area of the department of preventive and community physiotherapy. The study participants were trained ASHA workers. All 100 ASHA workers were included as per the eligibility criteria. After obtaining prior consent, all ASHAs were interviewed using a self-designed, semi-structured questionnaire.
STATISTICAL ANALYSIS USED: Data were analyzed in Excel and valid result and conclusion were drawn.
RESULTS: Majority of ASHA workers had correct knowledge about problems faced by women during breastfeeding (91%), breastfeeding positions (97%), and delivery positions (96%). They were lacking in knowledge about pelvic floor problems such as uterine prolapse and urinary incontinence. This research is conducted to identify the knowledge that ASHA has in the field of preventive women's health and childcare.
CONCLUSION: Despite the training given to ASHA workers, they are hardly aware about preventive measures for women's health and child development.

Keywords: Accredited Social Health Activist workers, awareness, childcare, women's health


How to cite this article:
Parle JA, Chougle S. Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey. Int J Health Allied Sci 2019;8:263-7

How to cite this URL:
Parle JA, Chougle S. Level of awareness among trained Accredited Social Health Activist workers in the field of women's health and child development – A survey. Int J Health Allied Sci [serial online] 2019 [cited 2019 Nov 22];8:263-7. Available from: http://www.ijhas.in/text.asp?2019/8/4/263/269249




  Introduction Top


Accredited Social Health Activists (ASHAs) are a group of workers launched by the National Rural Health Mission in 2005 who are trained to work as an interface between the community and the public health system.[1] ASHA constitutes of local village women who are married/widowed/divorced and fall in the age group of 25–45 years.[1] These women are given specific training in health, sanitation, maternal, newborn, and child health issues.[1] She is expected to provide primary medical care, control of disease by information, education, antenatal and postnatal services to women, counselling on family planning, safe abortion, child immunization, change in behavior in breastfeeding, newborn care, to create awareness on health and its determinants, and mobilizing community toward local health planning. Since ASHAs may be the first person reported by any pregnant women with symptoms suggestive of complications, it is important that ASHAs should be well aware of such symptoms so that immediate intervention can be done.[2] Their study structure consisted of seven different modules that are delivered in 23–25 days of the training period.[3] ASHAs provide a minimum package of curative care as appropriate and feasible for that level. Evidently, majority of the Indian population reside in the rural setup.[4],[5],[6],[7] They bear the responsibility of seeing the rural patients' firsthand due to poor doctor-population ratio, i.e., 1:1700 approximately.[8]

In developing countries such as India, women and child health issues in rural areas are tackled by primitive methods inspite of availability of health-care services which pose as a risk to increase morbidity and mortality among these vulnerable groups. Hence, it is important for the ASHA workers to have an understanding of the same to identify the risk factor at the early stage on these communities which, in turn, helps them to utilize the health-care services. These women are selected by the community, who are teamed and deployed to function in their own village.[9] Although the ASHA workers are trained on these modules, we aim to assess the ASHA workers' knowledge level in the field of women's health and childcare to see the efficiency of health workers in delivering the available health services.


  Subjects and Methods Top


A cross-sectional study was carried out at a Primary Health Center (PHC) coming under Panvel Taluka. The study was conducted from February 2016 to April 2016. A total 100 trained ASHA workers were approached in their respective PHC during their monthly review meeting. Prior permission was obtained from the medical officers of the respective PHCs before collecting Data. Consent was obtained, and the need of the study was explained in the language best understood by them. Self-made, semi-structured questionnaire was developed in English which was translated to Marathi, and content validity was done by the Institutional Ethical Committee. This validated questionnaire was then used for the research purpose. All ASHA workers were interviewed; data were collected regarding their knowledge and practice about women's health and child health. Data were analyzed using Microsoft Excel, Windows 7, and the results were presented as the percentage of number of ASHA with correct responses.


  Results Top


Data of 100 ASHA workers were included and analyzed in the study. All trained ASHAs were in the age group of 25–35 years. A survey was conducted to check their knowledge regarding recent advances. In our study, 75% of the ASHA workers had knowledge about importance of vaccination, 94% had knowledge about the effects of addiction during pregnancy, and 96% were aware about different positions of delivery. ASHA has good knowledge about breastfeeding positions (97%).

ASHA mentioned that lumps (27%); cracks (31%); retracted nipples (13%); engorged breast (8%); and others (16%) such as pain, tingling, tightness of the breast, difficulty in sucking, blood, and dryness, and bite wounds were breastfeeding problems as shown in [Figure 1]. [Figure 2] shows massage with cabbage leaves (35%), hot fomentation (6%), and uses primitive methods like self-breast examination for breast pain, breast swelling and lumps (23%), and 23% of the ASHAs said that proper diet, breastfeeding positions, shoulder exercises, and regular breastfeeding were preventive measures that they were aware about. In our study, 38% of the ASHAs were aware of back pain, 7% about stomach ache, 45% about weakness, and 10% about white discharge as pregnancy discomfort. [Figure 3] shows that ASHA were lacking in antenatal care (ANC) and postnatal care (PNC). They were aware of few basic exercises like Kegels exercises (13%), 34% advised daily walking, 20% advised to do only light work during pregnancy and 6% advised Yoga whereas 10 % suggested other methods such as proper diet, rest and breast massage but none of the advises were specific to either ANC or PNC.
Figure 1: Awareness of problems during breastfeeding

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Figure 2: Knowledge about preventive measures for breast problems

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Figure 3: Awareness about antenatal care and postnatal care exercises

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Eighty-two percent of the ASHAs were aware about uterine prolapse and 55% knew exercises for urinary incontinence. ASHAs mentioned that no weightlifting (17%), light work (18%), elevation (4%), surgery (6%), and medical help (11%) were the preventive measures they knew [Figure 4]. None of the ASHAs were aware about what can be given in uterine prolapse. They knew few dos and don'ts.
Figure 4: Awareness about prophylaxis of uterine prolapse

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To ascertain knowledge about child development, questions were asked about the milestone development of children up to 2 years. They were lacking in these aspects as seen in [Figure 5]. Awareness on unsupported sitting was (28%) crawling (54%), and recognizing family members and social smile (28%). Fifty-nine percent of the ASHAs were aware of head circumference changes in children, whereas 66% had knowledge about head holding, 67% knew about stair climbing fine motor activity (62%), walking (83%), and importance of baby cry immediately after birth was 97%.
Figure 5: Knowledge about childhood development

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As given in [Table 1], this study revealed that ASHA workers were aware about Rh factor compatibility (95%), consanguineous marriage, immunization, and group discussions for pregnant women but were comparatively less aware, i.e., 82% regarding contraception measures. They were aware about the importance of colostrum (100%). They were also well versed about childcare in preterms (98%), congenital conditions, knowledge about sucking, and swallowing in infants. Ninety percent were also knowing about the risk factors that may lead to an emergency delivery.
Table 1: Awareness in percentage

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  Discussion Top


The spectrum of the community health worker programs varies across countries on their objectives, roll-out, and management.[10] The current study was conducted on ASHA workers who qualified up to the seventh module. ASHA envisages a total period of 23 days training in five episodes. It is said that ASHA training is a continuous one and that she develops the necessary skills and expertise through continuous on the job training. Majority of ASHAs' age range between 25 and 45 years. Thus, majority of the ASHAs may be considered young, and this may be the strength for program as they are energetic and enthusiastic and may deliver better service with proper motivation and capacity building. However, in a study conducted in Karnataka,[11] it was observed that special training of ASHAs should be undertaken since one of the primary objectives of the ASHA program is to improve social justice. This is important and should be emphasized in both the training modules as well as routine supervision.

In the current study, knowledge about immunization was good; the same findings were observed in a study done in Surendranagar, i.e., 63%.[7] The response was good because these activities are associated with financial incentives. However, Wardha study shows that none of the ASHA worker had specific information on sthe chedule of immunization.[8]

ASHAs' services include advice for breastfeeding and provide ANC care. Majority of the ASHAs knew various positions for breastfeeding. A Haryana study showed similar results.[4] The current study reveals that 91% of the ASHAs were aware of complication which may arise during pregnancy. In a study in Haryana, vomiting and swelling on hands and feet are the major pregnancy problems that were listed while in this study it was found that back pain and weakness were the major pregnancy discomforts.[4] However, in this study, ASHAs' advice for walking, Yoga, or Kegels exercise was not specific to either antenatal phase or postnatal phase. Hence, the lacunae exist in knowledge specificity.

Unlike in earlier studies, our study included noncommunicable problems of women's health such as uterine prolapse and urinary incontinence, as this is a leading issue of women's health. While doing this study, it has been observed that many of ASHAs themselves were suffering with this. Here, we found that ASHAs knew the signs of prolapse, but none of them were aware about exercise to be given in uterine prolapse and urinary incontinence. They knew few dos and don'ts such as light work, not lifting heavy weights. Negligence toward this aspect was may be because these activities are not associated with financial incentives, and thus, more ignorance and hesitancy regarding these health issues in rural population was noted. However, the above health problems can be reduced by giving primary basic advice during ANC and PNC period. The current study reveals that there is no knowledge of preventive care as primary measure for such health issues which will be beneficial for strengthening health-care delivery. Wardha study shows that ANC services at village level were affected because of lack of participation of ASHAs in village health and nutrition day as there was a lack of clarity in role of health-care provision.[8] The study reveals a higher level of awareness in the incentive-based services. Hence, ASHAs preferred to do their duties that were associated with financial incentives. The same was observed in a Haryana study.[4] It was observed that ASHAs still advise to follow the primitive methods for certain health issues which is an absolute contraindication. Hence, during the training process, there is a need to concentrate on educating the ASHA for necessary primary medical care. Furthermore, further researches need to be conducted on their service delivery to find the efficiency of services that ASHA provides and the prevalence of superstitious or malpractices.

None of the study in India has been done in exploring infant's growth which is equally important for early detection of developmental delay and early intervention at rural level. There is grossly low level of knowledge regarding normal growth in infants. ASHAs should be aware of milestone development as child immunization occurs under the supervision of ASHA till 2 years of age. Hence, they should notice any development delay at the early stage. In India, the prevalence of urinary incontinence and uterine prolapse is high which is highly neglected area related to women's health. Furthermore, the prevalence of common motor disability of childhood such as cerebral palsy (CP) is high. Emphasis should be made on exploring this factor in future studies in a wider platform, and ASHA workers' training syllabus should be revised by considering these two aspects.

In a developing country such as India where most of the population reside in rural area, the strengthening of health-care facility is one of the tops most priorities of the government. As ASHAs are basic residents of community, they form a very effective link between delivery of health services and community. The training of ASHA is a backbone of capacity building and functioning of ASHA. Hence, it must be proper and effective. Hence, ASHA training module must monitor for periodical changes.[2]


  Conclusion Top


Despite the training given to ASHA workers, lacunae still exist in their knowledge regarding various aspects of preventive measures taken for women's health such as ANC, PNC, and normal development of a child between the age group of 0–2 years, especially in knowledge specificity. Periodical refresher training should be conducted for all the ASHA workers to strengthen their knowledge and inform them about the recent advances and changes in preventive approaches to various women's health and child development programs.

In future training sessions, more emphasis can be given on the implementation of preventive ANC and PNC measures and also child development. Monthly meeting should be used as a platform for regular reinforcement of various aspects of women's and child health.

Acknowledgment

We acknowledge all the participants who consented for the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
About accredited social health activist (ASHA). Available from: http://nrhm.gov.in/communitisations/asha.html. [Last accessed on 2018 Jan 07].  Back to cited text no. 1
    
2.
Kohli C, Kishore J, Sharma S, Nayak H. Knowledge and practice of Accredited Social Health Activists for maternal healthcare delivery in Delhi. J Family Med Prim Care 2015;4:359-63.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Asha Manual; Reading Material for ASHA Book No 1-7. Available from: http://nrhm.gov.in/communitisations/asha.html. [Last accessed on 2018 Jan 02].  Back to cited text no. 3
    
4.
Garg PK, Bhardwaj A, Singh A, Ahluwalia SK. An evaluation of ASHA workers' awareness and practice of their responsibilities in rural Haryana. Natl J Community Med 2013;4:76-80.  Back to cited text no. 4
    
5.
Shashank KJ, Angadi MM. A study to evaluate working profile of Accredited Social Health Activist (ASHA) and to assess their knowledge about infant health care. Int J Curr Res Rev 2013;5:97-103.  Back to cited text no. 5
    
6.
Shrivastava SR, Shrivastava PS. Evaluation of trained Accredited Social Health Activist (ASHA) workers regarding their knowledge, attitude and practices about child health. Rural Remote Health 2012;12:2099.  Back to cited text no. 6
    
7.
Mahyavanshi DK, Patel MG, Kartha G, Purani SK, Nagar SS. A cross sectional study of the knowledge, attitude and practice of ASHA workers regarding child health (under five years of age) in Surendranagar district. Healthline 2011;2:50-3.  Back to cited text no. 7
    
8.
Kumar U. India has Just one Doctor for Every 1,700 People. India: The New Indian Express; 2013.  Back to cited text no. 8
    
9.
Sundararaman T, Ved R, Gupta G, Samatha M. Determinants of functionality and effectiveness of community health workers: Results from evaluation of ASHA program in eight Indian states. Bio Med Central Proc 2012;6 Suppl 5:O30.  Back to cited text no. 9
    
10.
Gopalan SS, Mohanty S, Das A. Assessing community health workers' performance motivation: A mixed-methods approach on India's Accredited Social Health Activists (ASHA) programme. BMJ Open 2012;2:e001557.  Back to cited text no. 10
    
11.
Mony P, Raju M. Evaluation of ASHA programme in Karnataka under the national rural health mission. Bio Med Central Proc 2012;6 Suppl 5:12.  Back to cited text no. 11
    


    Figures

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